Provider Demographics
NPI:1356379259
Name:RAPHTIS, EFTHEMIOS (MD)
Entity type:Individual
Prefix:DR
First Name:EFTHEMIOS
Middle Name:
Last Name:RAPHTIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:RAPHTIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:432 W. UNIVERSITY DR.
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307
Mailing Address - Country:US
Mailing Address - Phone:248-651-6122
Mailing Address - Fax:
Practice Address - Street 1:432 W. UNIVERSITY DR.
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:248-651-6122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062940207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3178030Medicaid
F79689OtherHAP
103160OtherCARE CHOICES HMO
180020279OtherMEDICARE RAILROAD
MI180F362870OtherBCBS OF MICHIGAN
F36287004Medicare ID - Type Unspecified
MI3178030Medicaid